PSYCHOTHERAPY. 


.    33. 


ICAN   MEDICO-PeVCHOLOQICAL    AS6OCI 
INaTON,    D.  O.,   MAY,     limn. 


Y 


KM 


PSYCHOTHERAPY.  * 


By  Ralph  Lyman  Parsons,  M.  D., 

Private  Hospital  for  Mental  Diseases,  Greenmont-on- Hudson, 
Ossining  Postoffice,  N.  Y. 

The  fact  that  the  mind  has  an  important  influence  on  bodily 
conditions  is  very  well  understood.  The  subject  has  been  dis- 
cussed by  many  able  writers,  yet  it  is  of  so  great  importance 
that  it  is  always  worthy  of  consideration  and  of  re-considera- 
tion. It  may  be  that  this  is  especially  true  at  the  present  time, 
when  the  knowledge  of  the  physical  means  for  the  prevention 
and  for  the  cure  of  disease  has  become  so  great  as  to  divert  the 
attention,  in  no  small  degree,  from  the  potency  of  those  mental 
influences  which  are,  sometimes,  still  more  important. 

A  distinguished  philosopher  has  said,    "In  nature  there 'is 

nothing  great  but    man;  in  man  there  is  nothing  great  but 

mind."     It  might  be  added  that  the  mind  constitutes  the  man; 

v^  it  makes  him  what  he  is;  considered  in  its  broadest  sense,  it 

^comprises  whatever  in  his  being  is  not  material;  it  builds  up, 

"^controls  and  governs  the  body.     Even  when  the  physical  man 

^  is  asleep,  or  in   a  state  of  unconsciousness,  the  sub-conscious 

i    mind  is  always  active;  it  keeps  those  functions,  the  integrity  of 

^  which  is  essential  to  the  continuance  of  life,  in  a  state  of  activ- 
~^-~. ....  ... 

ity;  it  continues,  in  some  degree,  to  receive  impressions  from 

^  without;  and  these  impressions  may  and  often  do  become  the 
i   subjects  of  cerebral  activity. 

How  the  mind  may  affect  the  body,   in  a  state  of  health,  the 
'     excretions,  the  sweat,  the  saliva,  the  appetite,  the  digestion, 
^    the  catamenia,  the  capillary  circulation — as  in  blushing,  or  in 
e  pallor  caused  by  fear — is  too  well  known  and  of  too  fre- 
quent  occurrence  to  call  for  more  than  a  passing  notice.     In 
woman,  parturition  is  often  delayed  by  her  anxiety  for  seclu- 

*Read  at  the  Annual  Meeting  of  the  American  Medico-Psychological 
Association  held  at  Washington,  D.  C.,  May,  1903. 


2  PSYCHOTHERAPY. 

sion  and  quietude  during  the  great  crisis;  or  her  milk  is  sup- 
pressed, or  is  rendered  poisonous  by  an  accession  of  fear  or  of 
anger.  The  action  of  the  heart  is  habitually  more  or  less 
influenced  by  the  emotions  of  fear,  of  joy,  or  of  anger;  and  the 
effect  on  a  heart  that  is  weak  or  diseased  may  be  such  as  to 
stop  its  action  altogether,  as  in  the  case  of  the  late  Dr.  John 
Hunter.  The  sudden  blanching  of  the  hair,  through  mental 
shock,  is  not  of  infrequent  occurrence.  The  case  of  Louise 
Lateau  is  of  especial  interest,  as  an  illustration  of  the  influence 
of  fixed  attention  on  a  particular  part  of  the  body.  She  was  a 
devotee  and  had  contemplated  the  tragedy  of  the  crucifixion 
with  profound  attention  and  emotion.  On  Fridays  she  would 
lie  on  her  back,  with  her  arms  extended,  as  in  the  crucifixion. 
Each  afternoon,  while  she  was  thus  lying  in  a  state  of  deep 
religious  absorption,  the  stigmata  of  the  five  wounds  made 
their  appearance.  While  this  girl  was,  undoubtedly,  a  pro- 
nounced neurasthenic  and  of  a  hysterical  temperament,  there 
was  nothing  in  her  physical  condition,  nor  in  the  general  state 
of  her  health  that  would  at  all  account  for  the  occurrence  of 
the  stigmata.  Their  cause  was  mental  and  mental  only.  She 
was  so  closely  watched  by  physicians,  undoubtedly  both  capable 
and  honest,  that  physical  means  of  producing  the  stigmata  could 
not  have  been  employed  without  detection.  Many  similar 
cases  have  been  reported.  Sympathetic  pain  is  not  uncommon; 
as  when  a  person  experiences  severe  pain  in  some  part  of  the 
body  on  seeing  another  person  who  seems  to  be  suffering  from 
an  injury  in  the  same  location. 

The  influence  of  the  mind  on  the  body  may  be  so  profound 
and  so  persistent  as  to  be  a  cause  of  actual  physical  disease. 
Fear  often  renders  the  subject  especially  susceptible  to  epi- 
demic influences.  Fright  is  not  an  infrequent  cause  of  epilepsy. 
Fear  of  hydrophobia  may  cause  the  symptoms  of  the  disease, 
although  the  subject  has  not  been  inoculated  with  the  virus. 

On  the  other  hand,  the  agency  of  psychic  causes  in  the  cure 
of  ordinary  physical  disease  is  very  great;  but  at  this  point 
there  should  be  a  definite  understanding  of  what  is  meant  by 
the  term  psychotherapy. 

Psychotherapy,  then,  as  the  term  is  used  in  this  paper,  is  in- 
tended to  include  all  the  curative  agencies  in  action  which  are 
not  material  in  character;  and  also  all  immaterial  extraneous 


RALPH  LYMAN  PARSONS.  3 

influences  in  so  far  as  they  act  favorably  on  the  mind  of  the 
subject. 

In  many,  if  not  in  most  instances,  psychic  influences  are  in- 
timately associated  with  material  agencies;  as  with  drugs,  stim- 
ulants, diet,  bodily  exercise,  occupation,  condition  of  the  air, 
altitude,  climate,  etc.  But  the  associated  material  agencies  are 
here  so  obvious,  so  obtrusive  even,  that  they  oftentimes  re- 
ceive the  credit  of  being  the  real,  the  efficient  agencies  in  the 
cure  of  the  patient,  when  in  fact  their  influence  has  been  quite 
subordinate,  if  not  entirely  negative,  or  even  prejudicial  in 
character. 

And  so,  in  the  treatment  of  patients  who  suffer  from  any  dis- 
ease whatever,  it  should  be  borne  in  mind  that  however  well 
adapted  the  material  remedies  employed  may  be,  the  aid  of  the 
psychic  forces  should  also  be  brought  into  use  by  every  avail- 
able means.  To  this  end,  the  persons  associated  with  the  in- 
valid should  be  congenial  and  of  a  cheerful  temperament.  The 
physician  in  attendance  should  be  of  a  hopeful  temperament 
and  should  be  able  to  inspire  his  patient  with  hopefulness.  His 
pains-taking  care  in  making  his  examinations,  the  confident 
manner  in  which  he  states  his  conclusions  and  the  minuteness 
with  which  he  gives  his  directions  may  exert  an  important  in- 
fluence on  the  mind  of  the  invalid  and  in  no  small  degree  pro- 
mote his  chances  of  recovery.  Ignorant  charlatans  who  have 
the  ability  to  inspire  their  patients  with  hopefulness  and  con- 
fidence sometimes  succeed  in  effecting  a  cure  wrhen  learned  and 
skilled  physicians  who  lack  this  ability  have  failed. 

All  remedies  that  are  really  efficient  in  themselves  may  have 
and  usually  do  have  an  added  curative  effect  when  administered 
to  persons  of  intelligence  and  whose  mental  faculties  are  unim- 
paired. The  expectation  of  a  definite,  favorable  result  adds 
greatly  in  bringing  about  this  result.  The  strictness  and  par- 
ticularity with  which  directions  for  treatment  are  given  and 
carried  out  serves  to  stimulate  the  expectant  attention;  and  this, 
in  turn,  stimulates  the  psychic  forces  to  a  state  of  activity.  The 
hopefulness  engendered  by  the  fact  that  something  is  being 
done,  whether  by  the  administration  of  medicines,  baths,  elec- 
tricity, massage,  or  any  other  suitable  curative  means  aids  in 
bringing  about  the  desired  result.  While  material  agents  may 
destroy  organized,  living,  physical  structures,  they  can  never 


4:  PSYCHOTHERAPY. 

repair  nor  build  them  up  without  the  aid  of  the  psychic  forces 
as  the  builders. 

Not  only  do  the  psychic  forces  aid  material  remedies  in  the 
cure  of  diseased  conditions,  but  they  are  often  efficient  agents 
in  themselves.  As  the  expectation  of  a  fatal  result,  on 
the  part  of  the  patient,  may  lead  to  that  result;  so  encouraging 
assurances  of  recovery  are  often  efficient  in  promoting  recovery. 
An  exercise  of  the  will,  on  the  part  of  the  patient,  may  even 
overcome  the  adverse  influence  of  the  disease  and  an  unfavor- 
able prognosis  combined.  Skilled  physicians  sometimes  depend 
upon  the  psychic  forces  alone  in  the  treatment  of  their  patients, 
stimulating  hopeful  expectation  by  the  administration  of  sub- 
stances that  are  entirely  inert,  as,  for  instance,  in  giving  place- 
bos for  the  relief  of  constipation.  It  has  been  found  that 
motherless  babies  thrive  better  in  the  care  of  indigent  women 
at  their  destitute  homes  than  at  hospitals  where  their  food,  sur- 
roundings and  attendance  are  of  a  much  higher  order.  The 
mental  influence  of  the  foster-mother  on  the  baby,  the  mother- 
ing the  baby  gets,  in  the  former  case,  more  than  counterbal- 
ances the  advantages  afforded  by  the  hospital. 
/  Cures  are  undoubtedly  effected  through  the  agency  of  what 
are  called  the  Faith  Cure,  Mental  Healing,  Christian  Science, 
and  other  agencies  that  act,  in  the  first  instance  on  the  mind 
alone,  and  through  the  mental  forces  on  the  body.  From  time 
to  time,  healers  make  their  appearance  under  whose  mental 
influence  sufferers  from  physical  ailments  seem  to  be  cured;  and 
some  of  them,  undoubtedly,  are  cured.  They  leave  their  canes 
and  crutches  with  the  healer;  they  think  that  they  are  cured; 
they  can  now  do  what  they  could  not  do  before,  and  this  cer- 
tainly constitutes  a  cure.  And  so,  there  can  be  no  doubt  that 
many  of  the  pilgrims  to  Lourdes  and  to  other  religious  shrines 
are  really  cured  of  their  physical  disabilities,  and  that  these 
cures  are  effected  mostly,  if  not  altogether,  through  the  in- 
fluence of  the  mind.  Their  faith  has  healed  them.  If  this 
faith,  if  this  mental  influence,  can  be  brought  into  action  with- 
out the  intervention  of  the  healer,  without  the  pilgrimage  to 
the  shrine,  the  result  will  be  the  same.  If  the  mental  forces  of 
the  absent  patient  can  be  brought  into  favorable  action,  what  is 
called  absent  treatment  may  be  effective  without  the  presence 


RALPH  LTMAN  PARSONS.  5 

of  the  healer,  although  in  most  cases  the  presence  of  an  object- 
ive stimulant,  as  the  healer  or  the  shrine,  is  essential. 

It  is  by  no  means  to  be  inferred  that  all  mental  healers  and 
Christian  Scientists  are  dishonest,  or  are  knowingly  practicing 
a  fraud  upon  the  public.  On  the  contrary  >  some  of  them  have 
the  most  sublime  faith  in  the  efficacy  of  their  methods;  and  it 
is  largely  because  of  this  sublime  faith  on  their  part  that  their 
cures  are  brought  about.  They  inspire  their  patients  with 
something  of  their  own  hopeful  enthusiasm  and  thus  stimulate 
the  activity  of  the  real  agents  in  the  cure,  the  psychic  forces  of 
the  patient. 

The  ameliorations  and  cures  which  are,  undoubtedly,  effected 
through  hypnotism  depend  upon  the  same  principle.  In 
neither  case  is  there  any  emanation  from  the  agent  to  the  sub- 
ject. The  agent  simply  stimulates  the  psychic  forces  of  the 
subject  to  a  state  of  activity.  These  forces  alone  effect  all  the 
physical  changes  that  are  brought  about. 

Perhaps  the  most  striking  illustration  of  faith  in  the  efficacy 
of  inert  substances,  as  medicines,  is  to  be  found  in  the  use  of 
the  higher  attenuations  of  homeopathic  drugs.  A  single 
minim  of  the  tincture  of  any  drug  when  carried  to  the  thirtieth 
centesimal  attenuation  would  suffice  to  medicate  an  amount  of 
vehicle  so  enormous  as  to  be  quite  beyond  the  power  of  con- 
ception. A  globe  one  hundred  million  miles  in  diameter  would 
suffice  to  contain  only  a  small  fraction  of  the  supposed  medi- 
cine that  might  theoretically  be  made  from  one  minim  of  the 
mother  tincture.  The  amount  of  the  drug  in  each  dose  is  of 
course  correspondingly  diminished.  The  material  effect  of  a 
dose  of  this  supposed  medicine  must  be  utterly  inappreciable 
and  without  physical  effect.  And  yet  recoveries  follow  its  ad- 
ministration; and  physicians  of  a  high  degree  of  culture  and  of 
intelligence  have  faith  in  its  curative  power.  If  such  medicine 
does  have  curative  power,  it  must  certainly  be  through  pyscho- 
therapy. 

If  it  be  objected  that  such  cures  as  are  claimed  to  be  effected 
by  such  means  are  not  real  cures,  but  either  that  the  disease 
never  existed  or  that  the  cures  are  imaginary,  it  may  be  replied 
that  the  variety  of  both  disease  and  cure  is  quite  the  same  as  in 
analogous  cases  which  are  diagnosed  by  competent  physicians 
and  cured  by  means  of  material  remedies. 


6  PSYCHOTHERAPY. 

And  if  it  be  objected  that  the  psychic  forces  are  too  myste- 
rious in  their  nature  to  entitle  them  to  consideration,  it  may  be 
replied  that  material  remedies  are  no  less  mysterious  in  their 
mode  of  action.  We  know  nothing  of  the  fundamental  grounds 
of  their  activity  in  either  case. 

Thus  far  no  mention  has  been  made  of  the  psychic  forces 
with  reference  to  what  more  especially  concerns  the  members 
of  this  Association — the  treatment  of  diseases  involving  the  in- 
tegrity of  the  mental  faculties.  While  in  the  treatment  of 
mental  diseases  the  favorable  influence  of  certain  agencies 
which  act  directly  and  immediately  on  the  mind  is  understood 
and  appreciated,  it  is  very  doubtful  whether  the  full  measure 
of  their  importance  is  always  kept  in  view  and  the  principles 
involved  are  put  into  practice.  Nor  is  the  reason  for  this  far 
to  seek.  In  former  times  insanity  was  thought  to  be  a  disease 
of  the  mind  itself,  a  sort  of  demoniacal  possession  which  needed 
to  be  exorcised  rather  than  cured. 

In  opposition  to  this  view,  alienists  have  laid  so  much  stress 
on  the  doctrine  that  insanity  is  simply  an  expression  of  disease 
of  the  brain  that  they  have,  to  some  extent,  left  out  of  consid- 
eration the  psychic  forces  upon  which  the  functions  of  the  ma- 
terial body  depend  for  their  activity  and  their  integrity.  More- 
over, the  alienist  has  under  his  special  care  patients  whose 
mental  faculties  are  in  a  state  of  disorder;  and  who  are  conse- 
quently less  amenable  to  psychic  influences  than  those  who  are 
not  insane.  It  naturally  follows  that  physicians  who  are  en- 
gaged in  the  treatment  of  diseases  affecting  the  mind  are,  per- 
haps, more  likely  to  neglect  the  psychic  forces,  as  a  means  of 
cure,  than  are  those  physicians  who  are  especially  engaged  in 
the  treatment  of  physical  ailments. 

However,  alienists  do  fully  recognize  the  importance  of 
psychic  influences  on  the  insane  in  certain  particulars.  Thus 
all  are  agreed  that  such  patients  should  be  removed,  as  far  as 
possible,  from  disturbing  mental  influences;  and  that  their  sur- 
roundings, their  associations,  their  occupations  and  their  amuse 
ments  should  be  carefully  and  intelligently  adapted. 

But  much  more  than  this  is  needful  in  all  cases  in  which  the 
mind  is  still  responsive  to  mental  influences.  In  order  to  at- 
tain the  best  results,  as  careful,  individualized  mental  treat- 
ment should  be  prescribed  and  carried  into  practice  as  in  the 


RALPH  LYMAN  PARSONS.  7 

case  of  material  remedies.  Just  what  this  psychic  treatment 
should  be  must,  of  necessity,  depend  not  only  upon  the  condi- 
tion and  requirements  of  the  patient,  in  each  case,  but  also 
upon  the  temperament,  personal  experience,  aptitude  and  abil- 
ity of  the  physician  who  prescribes  and  of  the  agent  who  car- 
ries the  prescription  into  practice.  In  a  general  way,  the  fol- 
lowing suggestions  may  be  made,  by  way  of  illustration:  A 
patient  whose  intellectual  faculties  are  susceptible  of  improve- 
ment should  be  constantly  in  companionship  with  and  under  the 
influence  of  persons  of  sound  mind;  and  these  associates  should 
systematically  exert  that  influence  by  conversation  within  the 
sphere  of  the  patient's  intelligence,  and  by  calling  his  attention 
to  objectivities  in  connection  with  any  occupations  or  amuse- 
ments in  which  he  may  be  engaged.  It  is  not  to  be  inferred 
that  all  insane  patients  should  always  be  kept  from  companion- 
ship with  other  insane  patients.  On  the  contrary,  such  com- 
panionship may  be  so  arranged  as  to  make  it  a  beneficial  object 
lesson.  Insane  patients  often  perceive  and  understand  that  the 
ideas  and  acts  of  other  insane  patients  are  irrational;  and, 
whether  they  acknowledge  it  or  not,  are  led  to  suspect  that 
some  of  their  own  ideas  and  acts  may  also  be  irrational.  On 
the  other  hand,  the  intimate  association  of  large  numbers  of 
the  insane  is  without  advantage  and  may  be  detrimental.  This 
is  especially  the  case  when  those  who  are  associated  are  uncon- 
genial, or  when  many  sufferers  from  mental  depression  are 
kept  in  close  companionship. 

Schools  and  lectures  such  as  are  sometimes  employed  as  sub- 
stitutes for  or  as  adjuncts  to  individualized  methods  of  psychic 
treatment  are  of  advantage,  especially  in  the  larger  hospitals 
where  individualized  psychic  treatment  is  difficult  of  attain- 
ment. 

In  the  carrying  out  of  a  plan  of  individualized  psychic  treat- 
ment, the  due  exercise  and  stimulation  of  the  moral  faculties 
should  not  be  forgotten.  To  this  end,  the  patient  may  be  inter- 
ested and  occupied  in  the  care  of  animals,  or  in  doing  some- 
thing for  the  pleasure  or  the  benefit  of  others. 

The  highest  and  at  the  same  time  the  most  difficult  sphere 
for  psychotherapy  is  in  the  management  of  those  cases  of  in- 
cipient or  of  convalescent  insanity  which  are  characterized  by 
unfounded  suspicions,  hallucinations,  or  delusive  ideas.  And 


PSYCHOTHERAPY. 

here  it  is  well  to  ignore,  for  the  time  being,  at  least,  the  doc- 
trine that  insanity  is  always  and  only  a  symptom  of  disease  of 
the  brain.  It  will  be  helpful,  rather,  to  keep  the  facts  clearly 
in  mind  that  many  cases  of  insanity  have  their  beginnings  in  a 
brain  activity  which  is  due  to  mental  causes;  which,  in  the  first 
instance,  is  entirely  compatible  with  a  condition  of  sanity;  and 
that  the  continuance  of  this  abnormal  activity  often  results  in  a 
brain  habit  which  it  is  beyond  the  power  of  the  subject  to  con- 
trol; that  is,  the  psychic  cause  has  brought  about  a  condition 
of  insanity;  but  that  no  change  in  the  organic  substance  of  the 
brain  has  taken  place  may  be  inferred  from  the  fact  that  some 
of  these  patients  seem  to  recover  with  great  suddenness;  almost 
instantly,  indeed;  and  from  the  fact  that  they  recover  under 
the  influence  of  psychic  remedies  alone. 

The  following  history  may  serve  to  illustrate  the  causative 
influences  and  the  psychic  treatment  adopted  in  a  case  of  hallu- 
cinatory insanity. 

Miss  A. ,  a  young  woman  of  neurotic  heredity,  but  of  good 
physique,  good  social  position,  and  of  good  education,  suffered 
a  severe  mental  shock  through  social  disappointments  and  infe- 
licities. Her  appetite  became  impaired,  her  sleep  disturbed, 
and  her  power  of  self-control  greatly  diminished.  A  state  of 
hysterical  excitement  with  great  mental  depression  supervened. 
After  a  little  hallucinations  of  hearing  were  experienced.  She 
heard  voices  by  day  and  by  night,  talking  about  her,  making 
vile  accusations  against  her,  and  addressing  her  with  oppro- 
brious epithets.  She  insisted  that  the  voices  were  real,  that 
they  came  from  different  locations,  especially  from  a  room  over 
her  own,  and  demanded  that  her  persecutors  be  removed.  An 
examination  of  the  places  from  which  the  voices  seemed  to  pro- 
ceed did  not  remove  her  belief  in  their  reality.  The  irritation 
caused  by  the  voices  was  so  great  as  at  times  to  throw  her  into 
a  state  of  ungovernable  rage,  during  which  she  would  scream, 
slam  the  doors,  throw  articles  of  furniture  about  and  make  use 
of  violent  and  profane  language — acts  which  were  entirely  for- 
eign to  her  normal  habits.  Although  her  appetite  was  not 
especially  impaired,  she  had  lost  in  weight  and  become  decid- 
edly neurasthenic.  In  addition  to  the  usual  psychotherapeutic 
treatment,  removal  from  the  original  causes  of  mental  disturb- 
ances with  suitable  occupations  and  amusements,  such  tonic 


RALPH  LTMAN  PARSONS.  9 

remedies  were  prescribed  as  seemed  to  be  indicated.  After  this 
line  of  treatment  had  been  followed  for  a  period  of  time,  with- 
out a  favorable  result,  the  following  additional  psychothera- 
peutic  measures  were  adopted:  She  was  informed  that  in 
many  instances  persons  were  annoyed  by  voices  which  had  no 
existence;  that  if  they  were  able  to  convince  themselves,  or 
could  be  convinced  that  the  voices  had  no  real  existence  the 
annoyance  they  caused  would  be  greatly  diminished,  if  not 
quite  abolished.  She  was  told  of  persons  who  have  habitually 
heard  such  voices,  but  who  suffered  little  annoyance  from  them 
because  they  fully  understood  the  cause.  She  was  also  shown 
the  printed  history  of  such  hallucinated  persons,  in  corrobora- 
tion  of  the  oral  statements  that  had  been  made.  She  was  also 
told  that  she  ought  to  give  credit  to  the  testimony  of  reliable 
persons  who  assured  her  of  the  non- reality  of  the  voices;  that 
the  greater  part  of  all  she  knew  was  not  of  her  own  knowledge, 
but  was  founded  upon  the  testimony  of  others.  In  addition, 
the  mechanism  of  hearing  was  explained  to  her,  somewhat  as 
follows,  to- wit,  "You  see  that  lam  now  talking  with  you. 
You  hear  my  voice,  but  only  in  this  way.  The  words  1  am 
speaking  to  you  are  simply  a  vibration  of  my  vocal  organs. 
But  it  is  not  this  vibration  that  you  hear.  This  vibration  of 
the  vocal  organs  in  turn  causes  the  vibration  of  the  air;  of  the 
drum  of  the  ear;  of  the  little  bones  of  the  ear;  of  the  struct- 
ures within  the  ear;  of  the  nerves  that  lead  from  the  ear  to  a 
certain  part  of  the  brain  and  finally  of  the  cells  themselves.  If 
any  of  these  had  not  been  made  to  vibrate  there  would  have 
been  no  hearing.  But  now  that  the  cells  of  this  part  of  the 
brain  have  been  made  to  vibrate,  you  hear  my  voice.  Now,  if 
these  cells,  through  habit  or  through  any  other  cause,  should 
vibrate  in  the  same  way  when  I  am  not  speaking,  you  would 
seem  to  hear  my  voice  just  as  you  do  at  present.  I  cannot  give 
you  medicine,  nor  do  anything  that  will  stop  these  false  voices. 
But  if  you  will  accept  the  explanation  and  the  assurance  I  have 
given  you  I  have  no  doubt  that  they  will  cease  to  annoy  you; 
and,  then,  they  may  stop  altogether.  This  was  repeated,  on 
occasion,  when  the  patient  was  in  a  quiescent,  receptive  mood, 
and  in  a  restful,  recumbent  posture;  but  no  attempt  was  made 
to  induce  hypnosis.  As  was  hoped,  the  voices  soon  ceased  to 
annoy  and  after  a  little  ceased  to  be  heard  altogether.  With 


10  PSYCHOTHERAPY. 

the  stopping  of  the  voices,  the  other  manifestations  of  mental 
disturbance  passed  away.  The  patient  had  recovered. 
'  No  mention  has  been  made  of  hypnosis  as  a  means  of  placing 
insane  patients  in  a  receptive  state  of  mind,  when  an  attempt  is 
being  made  to  influence  their  mental  faculties;  in  part,  because 
the  result  would  be  very  uncertain  and  might  be  unfavorable; 
and  in  part  because  such  individuals  can  rarely  be  hypno- 
tized. They  are  usually  so  suspicious  or  are  so  much  absorbed 
in  their  own  ideas  that  they  do  not  readily  yield  themselves  to 
the  required  conditions.  In  lieu  of  this,  a  favorable  mental  in- 
fluence may  sometimes  be  exerted  by  advice  given  and  sugges- 
tions made  when  the  patient  has  fallen  into  a  natural  sleep,  or 
is  in  the  somnolent  state  between  sleeping  and  waking.. 

While  there  are  few  insane  patients  who  cannot  be  favorably 
influenced  by  psychotherapeutic  methods,  it  must  be  admitted 
that  the  great  majority  of  those  who  are  under  hospital  care  are 
not  very  susceptible  to  such  influence;  and  yet,  it  is  not  un- 
likely that  many  of  these  last  have  at  some  time  been  more 
susceptible  to  the  favorable  influence  of  psychotherapy  than  at 
present.  Indeed  there  is  reason  to  believe  that  there  are  few 
incipient  cases  of  insanity,  of  partial  insanity,  or  of  those  in 
the  convalescent  stage  which  may  not  be  benefited  by  carefully 
considered,  tactfully  applied,  and  thoroughly  individualized 
psychotherapeutic  measures. 

Assuming,  then,  that  psychotherapeutics  might  advantage- 
ously be  employed  with  greater  frequency  and  to  a  greater  ex- 
tent than  has  hitherto  been  done,  it  remains  to  be  inquired 
what  obstacles  are  to  be  removed  and  what  measures  are  to  be 
inaugurated  to  this  end.  It  is  obvious  that  the  person  who 
undertakes  the  practice  of  psychotherapy  in  a  given  case,  in 
addition  to  being  of  a  suitable  temperament  and  to  having 
made  a  careful  study  of  the  principles  involved,  should  gain 
the  entire  confidence;  and  should  be  on  terms  of  friendly,  sym- 
pathetic intimacy  with  the  patient.  After  having  become  thor- 
oughly conversant  with  the  history  and  mental  peculiarities  of 
the  case,  he  should  wait  patiently  for  a  favorable  opportunity, 
when  the  patient  is  in  an  agreeable  and  receptive  mood,  and 
then  exerci.se  such  special  mental  influences  as  may  be  within 
his  power;  repeating  his  advice,  his  teachings,  or  his  sugges- 
tions as  occasion  may  offer  the  opportunity.  The  time  which 


RALPH  LTMAN  PARSONS.  11 

may  seem  to  be  lost  in  waiting  is  not  really  lost,  if  the  agent  is 
suited  to  the  work  in  which  he  is  engaged.  His  influence, 
while  placing  himself  on  harmonious  terms  Avith  the  patient, 
may  be  really  no  less  helpful  than  his  more  systematic  efforts. 
The  exact  methods  to  be  employed  in  psychotherapy  must  of 
necessity  be  left  entirely  to  the  judgment  of  the  practitioner. 
On  the  one  hand  the  varieties  in  disposition,  circumstances,  edu- 
cation, mental  capacity,  and  vagaries  of  the  subject  are  almost 
infinite,  and  can  be  learned  only  by  personal  study;  and  on  the 
other,  the  variety  in  the  mental  status  and  equipment  of  agents 
who  will  be  suited  to  the  work  are  equally  great.  However,  in 
order  to  obtain  the  best  results  the  agent  should,  at  least,  be 
equal  to  the  subject  in  mental  capacity,  education,  culture,  and 
intelligence. 

Naturally,  the  physician  in  charge  would  be  the  person  best 
suited  to  put  the  methods  of  psychotherapy  in  practice;  but  in 
large  hospitals  for  the  insane  the  medical  superintendent  could 
rarely  undertake  this  duty,  on  account  of  the  time  that  would 
be  required.  The  task  might  even  be  too  great  for  the  mem- 
bers of  the  medical  staff.  In  this  case  it  might  be  advisable 
either  to  increase  the  number  of  the  medical  staff,  or  to  employ 
non-medical  assistants  who  are  especially  adapted  to  this  sort  of 
work.  Of  course  the  duties  of  such  assistants  should  be  en- 
tirely distinct  from  those  of  ordinary  nurses,  attendants,  or 
supervisors.  While  they  should  do  their  work  under  the  gen- 
eral direction  of  their  medical  superior  they  should  be  allowed 
to  choose  their  own  methods  and  to  carry  them  into  practice 
without  interference. 

In  a  paper  entitled,  "The  Constructive  Forces,"  which  was 
read  before  this  Society  a  few  years  ago,  u  special  reference 
was  made  to  the  immaterial  forces  through  which  and  by  which 
the  body  is  built  up  and  kept  in  a  state  of  repair.  It  is  the  ob- 
ject of  this  paper  to  suggest  a  consideration  of  the  influence 
which  the  immaterial,  the  psychic  forces  have  or  may  have 
upon  bo tii  body  and  mind  in  a  state  of  disease.  In  pursuance 
of  this  object,  reference  has  been  made  to  the  influence  of  the 
mind  upon  the  body,  in  a  state  of  health;  to  mental  states  as 
causes  of  ordinary  maladies,  and  to  their  influence  in  the  cure 
of  these  maladies;  to  mental  influences,  on  the  one  hand  as 
causes,  and  on  the  other  as  aids  in  the  treatment  of  insanity; 


_, 

•    J§      '•' 


12  PSYCHOTHERAPY. 

and,  finally,  to  some  of  the  conditions  which  are  required  for 
the  efficient  practice  of  psychotherapy  in  the  treatment  of  the 
insane. 


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